The response to Kimberly’s Story a couple of weeks ago was overwhelmingly positive. The story. The need. My own feelings on missed opportunities and a call to action by physicians in general and pathologists in particular. The comments, emails, phone calls, text, tweets and other social media discussion on the post are perhaps best summed up by one pathologist in his own words on a comment on a LinkedIn group.

Dr. Erik Burman, a practicing pathologist in California, describes in his own words, a summary of what I heard many say about pathologists serving as patient advocates beyond the microscope and pathology report.

It’s uncomfortable. I wish I had all the answers.

This is not something that I’m at all comfortable with but it has been a very important opportunity.

And it can make all the difference between being a good pathologist and an excellent pathologist.

Thank you for raising this very timely topic. Over the last year I have on occasion been drawn away from my microscope, out of my comfortable office and into the world of real live people. There has been an unfortunate cluster of friends and colleagues who have had to come to terms with breast cancer and their cases have come across my desk. I’ve also received calls from people who I don’t personally know but who have had questions about the details of their reports. This is not something that I’m at all comfortable with but it has been a very important opportunity. The most difficult part for me has been determining where to draw the line between explaining the technical aspects of my report versus providing clinical advice which is more appropriate for an Oncologist and Surgeon to explain.

There are levels to the question “what does it mean if my breast cancer in ER positive?” that go beyond the technical. The explanation that the tumor cells stained positive for estrogen receptor protein goes only so far. Invariably the real questions are “is that good or is that bad?” “How will it effect my therapy?” “What does that mean for my chances of cure?” Every detail of the report is being scrutinized in those terms. These are questions that most pathologists are not prepared for and don’t have to deal with in our daily practice.

It’s uncomfortable.

I wish I had all the answers.

It’s difficult to tell someone who’s looking to you for answers that you just don’t know.

I feel inadequate.

I feel like avoiding the situation but it’s good for the soul.

And it can make all the difference between being a good pathologist and an excellent pathologist.